Síndrome de médula anclada en pediatría. Presentación clínica, diagnóstico, etiología y resultados del tratamiento médico-quirúrgico.

Abstract

Background: Tethered cord syndrome (TCS) is the clinical manifestation of abnormal traction of the spinal cord, causing sensory-motor impairment of the lower limbs, scoliosis, low back pain, bladder and intestinal dysfunction; cutaneous abnormalities may be present. The diagnosis is suspected through clinical history and detailed physical examination. It is complemented by ultrasound and lumbosacral magnetic resonance imaging.

Methods: A retrospective study was carried out from April 2019 to October 2024. The inclusion criteria: a) Under 17 years old; b)symptoms and physical examination compatible with TCS; c) imaging diagnosis of TCS, and d) having undergone surgery. The results are reported at 12 months after surgery.

Results: Eighteen patients were evaluated, with an average age of 83.27 months (2-180). The etiology was hypertrophic filum (n = 6), dermal sinus (n = 4), lipomyelomeningocele (n = 4), lipomatosus filum (n = 2), and postoperative myelomeningocele (n = 2). The preoperative symptoms were bladder dysfunction 33.33%, constipation 33.33%, paraplegia 22.22%, paresthesia 22.22%, low back pain 22.22%, claw toes 16.66%, fever 16.66%, cerebrospinal fluid leakage 5.55%, club foot 5.55%, scoliosis 5.55%, and acute abdominal pain 5.55%. There were cutaneous stigmata in 61.11%. Magnetic resonance imaging was used in 17 patients and ultrasound in two. With surgery there was improvement in preoperative symptoms, the Wilcoxon test gave us a p < 0.001.

Conclusions: Surgery helps to reduce symptoms and prevent further neurological damage; in asymptomatic patients it prevents the risk of neurological injury.